A different kind of challenge lies in the age coverage in palliative care. While cancer tends to affect the older age groups and most palliative care patients are in the elderly age range, cancer may strike at any age. We are all experienced in looking after the younger patients, those in their twenties, thirties and forties. These patients are in their prime of life with their life contributions ahead of them and unfulfilled duties towards spouse, children or elderly parents. We know how much more care this group of patients need, both in the control of symptoms and emotional and spiritual support of the patient and the family. Many of us are less experienced at looking after children. Certainly in Singapore, most children with cancer or other fatal conditions remain under the care of their paediatricians, and are almost never referred to a hospice. In Britain, there are 10 hospices, a total of 90 beds, which cater especially for children. This is a more specialised area of palliative care which may require different expertise. Should children be cared for in a hospice unit for adults? Should the same staff look after them and their families? Should we be looking into building specialised children's hospices to cater to these needs? Would that be cost effective and would it provide better care for the patients and their families than in the existing system?
Teaching and research
Finally, I would like to look at the challenge for in-patient hospices that is the reason that St Christopher's Hospice was originally built for - not just as a home for the dying, but also as the teaching and research centre to push backwards the frontiers of knowledge, to improve the care given to the dying and to train young physicians, nurses, social workers and chaplains to go into this area of work. Given that in-patient hospice care is so much more expensive than home care, and Dr Shaw will be showing you some figures to compare the costs of those two types of care, can we justify building in-patient hospices just to look after patients? How many in-patient units do we need in order to care for the millions dying of cancer in countries like India and China? Surely, hospice home care is the answer to the problem of patient coverage, especially in developing nations. So is there a role for the in-patient hospice when resources are scarce and the problem in hand is immense?
